tbuckley/cabot-search huggingface dataset:
Abstract 10428: Probability of Atrial Fibrillation (AF) Diagnosis and Error in Estimation of Burden in People With Paroxysmal AF Based on the Duration of Monitoring
Authors: Victoria H Lee, Steve Steinhubl, Giorgio Quer
Journal: Circulation (2022)

Introduction: In individuals with paroxysmal atrial fibrillation (PAF) undergoing heart rhythm monitoring, total duration of monitoring can influence both the probability of recognizing AF and estimation of burden. We estimate the probability of AF detection and quantify the error in burden estimation based on the duration of monitoring up to 10 days. Methods: Data included 5361 ECG patch recordings up to 14 days long with at least 1 episode of AF. 100 samples of pre-specified lengths were drawn at random from each recording. For each sample length, the probability of identifying any AF, and the AF burden over shorter periods of monitoring were determined. The absolute error in burden estimation over short monitoring divided by the true AF burden during up to 14 days of monitoring was used to determine relative deviation. We stratified the expected relative deviation and probability of detecting AF by high (&gt;10%), moderate (2-10%), or low (&lt;2%) true AF burden. Results: Estimated probability of detecting any AF was significantly affected by duration of monitoring (Fig): 1 day of monitoring identified 76% [75-77%], 52% [51-54%] and 35% [33-36%] of individuals with high, moderate, and low burden of AF. Relative deviation in the estimation of AF burden is also significantly impacted by monitoring duration with 1 day recording, with 0.89 [0.87-0.91], 1.45 [1.43-1.47], and 1.65 [1.63-1.67] for high, moderate, and low burden. Even for 7 days recording, the expected deviation is significant, with 0.31 [0.30-0.33], 0.60 [0.58-0.61], 0.79 [0.78-0.80] for high, moderate, and low burden (Fig). Conclusions: In people with PAF, known or unknown, the duration of continuous ECG recording can significantly impact both ability to diagnosis AF and accurate determination of AF burden. Even in individuals with true AF burden &gt;10%, 24 hours of monitoring will not detect AF in &gt;20% of people and provide an almost 90% relative error in the estimate of AF burden.
Abstract 10255: The Evolving Impact of Myocardial Injury in COVID-19 Patient Amid the Omicron Wave of the Pandemic
Authors: Brian C Case, Corey Shea, hank rappaport, Matteo Cellamare, Cheng Zhang, Mason Zhu, Sant Kumar, Giorgio A Medranda, Lowell F Satler, Ron Waksman, Toby Rogers, Ron Waksman
Journal: Circulation (2022)

Introduction: Coronavirus disease 2019 (COVID-19) with evidence of myocardial injury, defined as troponin elevation, has been demonstrated to be associated with worse outcomes. The temporal changes in outcomes in these patients during various phases of the pandemic remain unclear. Hypothesis: We sought to evaluate outcomes during the Omicron phase compared to previous phases of the pandemic. Methods: We analyzed COVID-19-positive patients with myocardial injury who presented to the MedStar Health system (11 hospitals in Washington, DC and Maryland) during Phase 1 of the pandemic (March 1 - June 30, 2020), Phase 2 (October 1, 2020 - January 31, 2021) and Phase 3 (Omicron) (December 1, 2021 - March 31, 2022) comparing their characteristics and outcomes. The primary end point was in-hospital mortality. Results: The cohort included 2079 COVID-19-positive admitted patients for whom troponin-I or high-sensitive troponin was elevated (Phase 1: n=150, Phase 2: n=854, Phase 3 [Omicron]: n=1075). Baseline characteristics were overall similar. Inflammatory markers were significantly elevated in Phase 1 as compared to Phase 2 and the Omicron Phase. The use of remdesivir and dexamethasone was most seen in Phase 2. In the Omicron Phase, 52.6% of patients were fully vaccinated. In-hospital mortality although high was lower in the Omicron Phase as compared to Phase 1 and Phase 2 (23.3% vs. 59.3% vs. 28.1%; p&lt;0.001). Those vaccinated demonstrated even more favorable outcomes as compared to those patients unvaccinated (18.3% vs 24.2%, p = 0.042). Conclusions: COVID-19 patients with elevated troponin during the Omicron Phase still have significant mortality rates despite overall improved outcomes when compared to the first and second waves of the pandemic. This improvement in outcomes could be attributed to the implementation of the COVID-19 vaccine, advances in available COVID-19 treatment options, provider experience with the novel disease and less virulent variants.
Abstract 10454: Heart Failure With Recovered Ejection Fraction is Good Therapeuticmerkmal for Adaptive-Servo Ventilation Therapy in Patients With Heart Failure
Authors: TAKAAKI FUJII, Noriaki Takama, Ryutarou Iwai, CHIKA KODAMA, DAIKI TAKIZAWA, Naoki Yuasa, Shiro Amanai, Takahiro Kuno, Tomonari Harada, Hiroshi Hasegawa, Takashi Kobari, Yohei Ishibashi, Kazufumi Aihara, Hidemi Sorimachi, Shuntaro Tamura, Toshimitsu Kato, Masaru Obokata, Yoshiaki Ohyama, Norimichi Koitabashi, Yoshiaki Kaneko, Hideki Ishii
Journal: Circulation (2022)

Introduction: Heart failure with recovered ejection fraction (HFrecEF) is a complex clinical entity in which biology and clinical management. Previous clinical trial showed adaptive-servo ventilation (ASV) therapy is harmful for patient with heart failure with reduced ejection fraction (HFrEF), whereas we can initiate ASV for patients with HFrEF by adhering rigidly to Japanese statement about the proper use of ASV for HF. Hypothesis: It is still unclear whether ASV therapy is really harmful in patients with HFrecEF. Our aim is to estimate that ASV therapy is really harmful in patients with HFrecEF by estimating biomarkers and fatal cardiovascular events. Methods: The study group consisted of 78 patients with HF (age;70±12 years). Baseline LVEF was 27.8±8.5%. After optimal medical therapy, ASV was initiated as an additional HF treatment. After 6-month follow-up, we classified into 2 groups by result of LVEF after ASV therapy. Group A (n=20) was categorized as HFrecEF {low pre-LVEF (&lt;45%) and improved post-LVEF (≧45%)}, Group B (n=58) was categorized as HFrEF {low pre-LVEF (&lt;45%) and not improved post-LVEF (&lt;45%)}. We estimate the changes of BNP and fatal cardiovascular events after ASV therapy. Results: Before ASV therapy, BNP did not show significant difference in 2 groups {Group A: 439(149-1344) pg/ml vs. Group B: 531(265-892) pg/ml, p=0.73}. After ASV therapy, the changes of BNP showed significant differences (Figure 1A), LVEF also showed significant differences in 2 groups (Group A: 52.3±7.5% vs. Group B: 30.8±3.7%, p=0.039). The fatal cardiovascular events rate after three-year follow-up showed significant good prognosis in Group A (Figure 1B). Conclusions: Our study showed that approximately one in four patients can change from HFrEF to HFrecEF, and ASV is acceptable and effective treatment for patients with HFrecEF by contributing to low fatal cardiovascular events and improvement of BNP level.
Abstract 10256: Current Indications for Surgery for Severe Mitral Regurgitation Predict Higher Risk of Mortality in Women Compared to Men
Authors: Bryan Abadie, Paul C Cremer, A MARC GILLINOV, Leslie Cho
Journal: Circulation (2022)

Introduction: Studies have shown that mitral valve repair (MVr) for severe mitral regurgitation (MR) restores normal life expectancy in men, but not in women. The reasons for this difference in long term mortality are unknown. The purpose of this study was to evaluate men and women who underwent isolated mitral valve repair and compare differences in mortality for the current AHA/ACC class I indications for surgery: symptoms, ejection fraction (EF) ≤ 60%, and left ventricular internal dimension at end-systole (LVIDs) ≥ 4.0 cm. Methods: All patients who underwent isolated mitral valve repair for the primary indication of degenerative MR at a single institution between 1994 and 2016 were screened. Patients were excluded if they underwent a concomitant surgical intervention or did not have 1 year of follow up data. Results: A total of 12,880 patients underwent surgery for severe degenerative MR of which 5,267 had an isolated MVr and 1 year of follow up data. There was 3,159 men and 2,108 women in the study. Men and women had similar age and pre-operative ejection fraction, with some difference in pre-operative comorbidities (see Figure). EF was a predictor of death in both women and men, although the hazard ratio was higher in women [HR 1. 78 (CI 1.30 - 2.40, p = 0.017) vs 1.37 (CI 1.06 - 1.78, p &lt; 0.001)]. In men, symptoms (HR 0.98 CI 0.73 - 1.31, p = 0.878) and increased LVIDs (HR 1.12 CI 0.87 - 1.62, 0.277) did not predict mortality. However, in women, the presence of symptoms did predict death (HR 1.80 CI 1.06 - 3.05, p = 0.029). An increased LVIDs trended towards death but did not quite meet statistical significance (HR 1.41 CI 0.99 - 2.00, p = 0.059) in women. Conclusion: The non-gender-specific thresholds for mitral valve surgery in the current guidelines may underestimate disease severity in women as they were associated with an increased risk of death compared to men. Therefore, delaying surgery until women meet these thresholds may be exposing them to undue harm.
Abstract 10421: Factors Associated With Early and Late Restenosis Following Drug-Coated Balloon Treatment for Patients in Femoropopliteal Lesions
Authors: Taku Toyoshima, Osamu Iida, Mitsutoshi Asai, masaharu masuda, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takuya Tsujimura, Yasuhiro Matsuda, Yosuke Hata, Hiroyuki Uematsu, Naoko Higashino, Sho Nakao, Tomofumi Tsukizawa, Masahiko Fujihara, Kunihiko Nishian, DAIZO KAWASAKI, Mitsuyoshi Takahara, Toshiaki Mano
Journal: Circulation (2022)

Introduction: Drug-coated balloon (DCB) improves clinical outcomes and has created a paradigm shift in the treatment of femoropopliteal (FP) lesions. However, in real-world FP practice, we occasionally experience early restenosis after DCB treatment despite the achievement of angiographic success at initial endovascular treatment (EVT). The objectives of this study was to elucidate factors associated with early (within 6-month) and late restenosis (after 6-month) following DCB treatment for real-world FP lesions. Methods: This was a multicenter and retrospective study enrolling 486 lesions (lesion length: 12±10 cm, chronic total occlusion [CTO]: 21%, involving popliteal arterial lesions: 43%) in 423 patients (age: 74±9 years, female: 29%, diabetes mellitus: 61%, hemodialysis: 38%, chronic limb-threatening ischemia: 42%) who underwent EVT using DCB between January 2018 and December 2019 in three cardiovascular centers. The outcome measure was primary patency, and the predictors of early and late restenosis were explored by cox proportional regression analysis. Results: During the mean observation period of 25.3±12.1 months, primary patency at 6-, 12-, 24-, and 36-month was 93.1%, 79.1%, 61.6%, and 48.7%, respectively. A total of 31 lesions and 138 lesions developed early and late restenosis, respectively. Multivariate analysis revealed that CTO lesion (Hazard ratio [HR]: 2.29, p=0.033) and involving ostial lesion of superficial femoral artery (HR: 2.73, p=0.009) were significantly associated with early restenosis, while calcification angle over 270° (HR: 1.66, p=0.005), smaller distal external elastic membrane (EEM) diameter evaluated by intravascular ultrasound (HR: 1.03, p&lt; 0.001) and involving popliteal arterial lesions (HR: 1.53, p=0.018) were significantly associated with late restenosis. Conclusions: The factors associated with early&amp;nbsp;restenosis following DCB treatment for real-world FP lesions differed from those with late restenosis.
Abstract 10979: Long Term Risk of Coronary Artery Disease in Breast Cancer and Lymphoma Patients After Chemotherapy Plus Radiation Treatment vs Chemotherapy Only
Authors: Mariana Garcia-Arango, Carolyn M Larsen, Rafael E Toro-Manotas, Bryan Vallejo, Renzo J Mogollon, Juan Quintero Martinez, Christopher Scott, Luis E Fong de los Santos, James Cerhan, Tufia C Haddad, Carrie Thompson, Robert W Mutter, Daniela Stan, Hector R Villarraga
Journal: Circulation (2022)

Introduction: patients exposed to chest, breast or mediastinal RT, may present with accelerated atherosclerosis and CAD due to diffuse micro and macrovascular fibrosis. However, CAD risk has not been well established in a community-based study. Aims: Describe CAD risk in patients treated with chemotherapy with and without RT and evaluate the cumulative incidence of CAD (coronary revascularization, MI and abnormal stress test and coronary angiogram). Methods: From 1985-2010, we identified 744 patients with a new diagnosis of breast cancer or lymphoma, using the Rochester Epidemiology Project (REP) who received chemotherapy with or without RT. CAD risk was assessed by a proportional hazards model for time to event. RT was treated as a time dependent co-variable, with index date being chemotherapy start date, significance was considered as a p&lt;.05. Characteristics were evaluated by a multivariable Cox model to consider RT and time censoring. Results: 744 patients treated with chemotherapy were identified, of these 488 (65.6%) had breast cancer, 256 (34.4%) lymphoma, and 367 (49%) also received RT. The mean total RT dose was 5.5 ± 1.2 (Gy) for those that had CAD and 5.4 (Gy) ± 1.1 for non-CAD patients, p=0.4. The cumulative incidence of CAD events (accounting for death as a competing risk) at 5 and 10 years of follow-up was 1.9% (CI 1.14-3.2) and 3.06% (CI 2.01-4.7), respectively p&lt;.05 figure1. Baseline differences between those receiving RT or not, were not significant for DM and HTN; however, males and ages 70-79 were less likely to receive RT, table1. In a multivariable model, there was no difference in the CAD outcomes between those with and without RT, HR= 1.21 [0.48-3.06] p=.69, after adjusting for age, gender, DM, and HTN and those &lt;49 y/o had a lower risk of CAD. Table2 Conclusion: In this REP retrospective cohort study, the risk of developing a CAD event was similar between chemotherapy plus RT and chemotherapy only regimens, even after considering gender, age, HTN and DM.
Abstract 10399: Population-Level Implications of Empagliflozin for Heart Failure With Preserved Ejection Fraction in the United States
Authors: Khawaja Muhammad Talha, Javed Butler, Stephen J Greene, Rahul Aggarwal, Stefan D Anker, Muthiah Vaduganathan, Gregg C Fonarow
Journal: Circulation (2022)

Introduction: The indication for empagliflozin has been expanded to patients with heart failure (HF) and left ventricular ejection fraction (LVEF) &gt;40% after findings of significant reduction in HF hospitalizations (HFH) and cardiovascular mortality (CVM) in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial. Objective: To quantify the estimated United States population-level impact of reducing worsening HF events with empagliflozin in LVEF &gt;40%. Methods: A projected adult HF population (age &gt;18) eligible for empagliflozin, obtained using weighted data from the National Health and Nutritional Examination Survey (2015-2018) was mapped onto newly eligible LVEF distributions, &gt;40% overall and those &gt;40% to 65% from the Get With The Guidelines Heart Failure registry. Number needed to treat (NNT) at 3 years for worsening HF events (urgent HF visits, total HFH and CVM) and total HFH, were calculated using rate difference from the EMPEROR program to estimate population-level treatment effects. Results: A projected 4,794,524 adults with HF are eligible for empagliflozin therapy. The population was predominantly male (57%) and white (67%), with a mean age of 66 years. Of this total population, 2,619,248 would be estimated as newly eligible with LVEF &gt;40% and 2,310,960 with LVEF &gt;40% to 65%. A projected 923,426 (95% CI, 769,893 – 1,076,959) worsening HF events would be prevented across the LVEF spectrum with empagliflozin over 3 years, out of which 301,738 (95%CI: 251,570, 351,906) and 295,341 (95%CI: 246,236 – 344,446) would be prevented in LVEF &gt;40% and LVEF &gt;40% to 65% subgroups, respectively. Moreover, an estimated 614,179 (95% CI, 512,063 – 716295) total HFH events would be prevented across the LVEF spectrum, out of which 201,159 (95%CI: 167,713 – 234,604) and 218,386 (95%CI: 182,076 – 254,696) total HFH events would be prevented in LVEF &gt;40% and LVEF &gt;40% to 65% subgroups, respectively. Conclusions: In addition to the proven benefit in HF with LVEF ≤40%, optimal implementation of empagliflozin in the US for treatment of HF with LVEF &gt;40% has the potential to prevent/postpone an additional 300,000 worsening HF events over 3 years.
Abstract 10557: A Case of Cardiogenic Shock in a Woman With a Mitochondrial Cardiomyopathy
Authors: Andrew A Girard, Brittain F Heindl, Stephen Clarkson, Silvio Litovsky, Eroboghene Ubogu, Coreen Schwartzlow, Jose Tallaj
Journal: Circulation (2022)

Case Presentation: A 35-year-old woman with nonischemic cardiomyopathy, with a left ventricular ejection fraction &lt;20% on home dobutamine, and chronic weakness was referred to our institution for heart transplantation evaluation. She was directly admitted to the hospital for suspected cardiogenic shock after her labs revealed a lactate level of 5.4 mmol/L. Her hospital course was complicated by persistently undulating lactate levels (0.2 - 8.6 mmol/L) that increased with exertion, despite normal mixed venous oxygen saturation measurements obtained from a pulmonary artery catheter. Serologic genetic testing was negative, and electromyography revealed the presence of a proximal and axial myopathy. A deltoid muscle biopsy was obtained, and genetic testing of the specimen revealed two mitochondrial deoxyribonucleic acid deletions, and electron microscopy revealed mitochondrial paracrystalline inclusions. She subsequently underwent left ventricular assist device placement and was started on carnitine, arginine, creatine, thiamine, and coenzyme Q10 supplementation. Despite left ventricular assist device placement, the patient has continued to decline due to progressive right heart failure and is currently being considered for cardiac transplantation. Discussion: Mitochondrial cardiomyopathy (MCM) is an alteration in cardiac structure and function caused by genetic defects of the mitochondrial respiratory chain, in the absence of other causes of heart failure. The true prevalence of MCM is unknown. Clinical manifestations in those with MCM present on a spectrum, ranging from asymptomatic cases to those with signs and symptoms typical of heart failure. Extra-cardiac features commonly include chronic weakness and fatigue. Diagnosis is made with prompt genetic testing and microscopic evaluation of a skeletal muscle biopsy specimen. Outcomes in patients who receive a left ventricular assist device are unknown and warrant further investigation.
Abstract 10905: Relationship of Eicosapentaenoic Acid and Docosahexaenoic Acid Dosage to Plaque Progression in Patients With Coronary Atherosclerosis Receiving Statin and Polyunsaturated Fatty Acid Therapy
Authors: John P Sheppard, Suvasini Lakshmanan, Sion K Roy, Deepak L Bhatt, Matthew J Budoff, John R Nelson
Journal: Circulation (2022)

Introduction: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 polyunsaturated fatty acids (PUFAs) extensively studied in atherosclerosis. Clinical endpoint and imaging studies have yielded convergent findings favoring pure EPA over mixed EPA/DHA formulations. The effects of EPA and DHA dose on coronary plaque dynamics, however, remain unknown, and could yield insights into the utility of these PUFAs in coronary artery disease. Methods: We considered longitudinal studies that compared coronary plaque change in patients receiving statin versus statin+PUFA therapy. Outcomes were % change in total and lipid plaque volume. Treatment effects were calculated as standardized mean difference (SMD), the mean % plaque volume change between statin and statin+PUFA cohorts divided by their pooled standard error. To isolate effects of EPA or DHA dose respectively, treatment arms were pooled by dosage of the PUFA of interest. To account for dependent samples, we fit hierarchical mixed effects models using robust variance estimation, assuming a correlation of 0.5 among treatment effects within multi-arm studies. Results: Among 555 screened articles, 11 studies met inclusion criteria. Among 1,070 patients, there were 14 treatment arms stratified by EPA dose, and 15 treatment arms stratified by DHA dose. Meta-regression revealed that EPA dose (g/day) correlated positively with treatment effect (β = 0.3 [0.1, 0.6], P = 0.02), while daily DHA dose correlated negatively with treatment effect (β = -0.4 [-0.7, -0.1], P = 0.01). We found no associations between EPA (β = 0.1 [-0.2, 0.4], P = 0.44) or DHA (β = -0.1 [-0.3, 0.2], P = 0.59) dose and treatment effects for lipid volume (Figure 1). Conclusions: Among cohorts receiving statin+PUFA therapy, we found a dose-dependent benefit of administered EPA on coronary plaque volume; the opposite was true for DHA. This adds to a growing body of evidence suggesting DHA may blunt beneficial effects of EPA in atherosclerosis.
Abstract 10038: Combined Low Endothelial Shear Stress and High Plaque Structural Stress Heterogeneity Predicts Non-Culprit Major Adverse Cardiovascular Events; Insights From the PROSPECT Study
Authors: Sophie Z Gu, Mona E Ahmed, Yuan Huang, Diaa Hakim, Chuck Maynard, Nicholas Cefalo, Ahmed U Coskun, Charis Costopoulos, Akiko Maehara, Gregg Stone, Peter H Stone, Martin R Bennett
Journal: Circulation (2022)

Introduction: Low endothelial shear stress (ESS) is a pro-atherogenic stimulus associated with coronary plaque development, while high plaque structural stress (PSS) and its heterogeneity is associated with plaque destabilization. Previous studies showed that combining ESS and PSS additively predicts plaque progression, but no studies have determined their ability to predict major adverse cardiovascular events (MACE). We examined whether combining ESS and PSS improves MACE prediction in patients with acute coronary syndrome. Methods: We examined baseline ESS, ESS gradient, PSS, and PSS heterogeneity index (HI) in 22 non-culprit lesions (NCL) leading to future MACE, and 64 randomly selected control NCLs without MACE from the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study. ESS was calculated by computational fluid dynamics and PSS by finite element analysis on co-registered lesions. Results: 86 lesions (55 thin-cap and 31 thick-cap fibroatheromas) were analyzed from 67 patients. Lesions that caused future MACE showed baseline higher PSS HI (0.32 vs. 0.24, p&lt;0.001), lower ESS (0.56 vs. 0.91 Pa, p=0.007), higher ESS gradient (3.82 vs. 1.96 Pa/mm, p=0.007), smaller minimum lumen area (MLA, 3.83 vs. 5.05 mm 2 , p=0.002), and larger plaque burden (PB, 70% vs. 59.4%, p&lt;0.001). Independent predictors of MACE in multivariate analysis included high PSS HI (hazard ratio [HR] 3.9, 95% confidence interval [CI] 1.5-10.4, p=0.006), high ESS gradient (HR 3.4, 95% CI 1.4-8.1, p=0.007), and high PB at the MLA (HR 2.6, 95% CI 1.1-6.3, p=0.035). Combining low ESS and high PSS HI improved test specificity to 0.83 and positive predictive value (PPV) to 59.3%, while maintaining high sensitivity at 0.73 and high negative predictive value (NPV) at 89.8%. Combining low ESS, high ESS gradient, and high PSS HI further improved prognostication, predicting 80% of MACE over 3-year follow-up (p&lt;0.001). Conclusions: Combining baseline low ESS, high ESS gradient and high PSS heterogeneity significantly improves risk stratification of NCLs over each parameter alone. Combining parameters exceeds PPV and NPV achieved by imaging alone, and may identify lesions suitable for preemptive intervention strategies to avert future MACE.